Salivary Gland Cancer

Salivary gland cancer commonly refers to the cancer that develops in the parotid gland, situated just in front of the ear.

However, sublingual and submandibular glands or any other tiny salivary glands present in the cheeks and throughout your mouth and throat may also be affected.

Surgery is often a definitive treatment for salivary gland cancer while other treatments may include radiation therapy and chemotherapy.

The common signs and symptoms of salivary gland cancer are:

• A hard mass or swelling on or near your jaw or in your neck or mouth,
• Numbness in part of your face,
• Muscle weakness on one side of your face,
• Persistent pain in the area of a salivary gland,
• Difficulty swallowing,
• Trouble opening your mouth widely.

When to see a doctor?

Talk to your doctor if you experience any signs or symptoms that worry you. Visit your doctor if you notice a lump or swelling near your salivary gland which is the most common but necessarily a sign of a salivary gland tumor. Note that most cases of salivary gland tumors are non-cancerous and a swelling in salivary gland can be caused by an infection or a stone in a salivary gland duct.

The cause of salivary gland cancer has not been established yet. It is thought to occur form DNA changes in the cells of a salivary gland (DNA mutations). These mutations cause out-of-control growth and multiplication of cells. These abnormal cells live longer and accumulate to form a tumor that can invade nearby tissue or may spread (metastasize) to distant body parts. The types of salivary gland cancer based on the type of cells involved in the tumor.

There are various types of salivary gland cancer based on the type of the cells involved. They are: 

• Acinic cell carcinoma,
• Adenocarcinoma,
• Adenoid cystic carcinoma,
• Clear cell carcinoma,
• Malignant mixed tumor,
• Mucoepidermoid carcinoma,
• Oncocytic carcinoma,
• Polymorphous low-grade adenocarcinoma,
• Salivary duct carcinoma,
• Squamous cell carcinoma.

Making a diagnosis of salivary gland cancer is done by performing several tests.

Talk to your doctor of dentist if you experience any signs. If suspected of having a salivary gland tumor, you may be referred to a maxillofacial surgeon (a surgeon who specializes in operations involving the head and neck). The team may contain other specialists like doctors who treat cancer (oncologists) and doctors who specialize in head and neck problems (otorhinolaryngologists)

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Make a list of the questions to ask your doctor. Some typical questions can be: 

• Do my symptoms indicate salivary gland cancer? 
• What type of salivary gland cancer do I have? 
• Has my cancer spread to other tissues? 
• What are my treatment options and side effects of each option? 
• Is my condition curable? 
• Will treatment interfere with activities like eating or speaking? 
• How will my appearance be affected by the treatment? 
• Do I need to see a specialist?  

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• When did the symptoms first appear? 
• Have your symptoms been continuous or occasional and how severe are they? 
• Does anything improve or worsen your symptoms? 

The diagnosis typically begins with a physical exam in which your doctor will look for swelling or a mass in your jaw, neck and throat. Some other tests include:

• Imaging tests: Magnetic resonance imaging (MRI) and computerized tomography (CT), can be used to determine the size and location of the tumor. 
• Biopsy: A sample of cells from the affected area is removed by a needle, and sent to the lab for further analysis. 

Staging Salivary Gland Cancer

Staging the cancer helps in selecting treatment options and predicting outcomes. Cancer stages are indicated by Roman numerals, with stage I referring to a localized tumor and stage IV an advanced cancer that has spread beyond your mouth.

The treatment may vary according to the type, size and stage of salivary gland cancer, and usually involves surgery, with or without radiation therapy. 

Surgery for salivary gland cancer may include: 

• Removing a portion of the affected salivary gland: This might be an option for small and easily accessible tumor. 
• Removing the entire salivary gland: This might be an option for a larger tumor. If affected by cancer, nearby structures such as the facial nerves may also be removed. 
• Removing lymph nodes in your neck: If affected by the cancer, most of the lymph nodes in your neck (neck dissection) is removed by surgery.
• Reconstructive surgery: A reconstructive surgery is done to repair or replace bone, skin or nerves that have been removed during your surgery. This surgery aims to improve your ability to chew, swallow, speak or breathe after surgery. 

Surgery is often associated with nerve damages that may result in facial paralysis. The outcome of the surgery and damages to your nerves largely depend upon skill and judgement of the surgeon.

• Radiation therapy: It uses ionizing radiation like X-rays to kill cancer cells and may be used after surgery to destroy the cells that have survived surgery. It may also be an option to treat a large or inaccessible salivary gland cancer. 
• Chemotherapy: It uses chemical drugs to kill cancer cells. It’s an option for treating advanced salivary gland cancer that has spread to distant body parts.

No alternative and homeopathic remedies can cure salivary gland cancer. But alternative medicine treatments may help you cope with salivary gland cancer and the side effects of cancer treatment.

Complementary treatments for fatigue include:

• Exercise: Perform any low intensity exercise such as brisk walking, during and after cancer treatment to minimize tiredness. Always consult your doctor before starting any new exercise program. 
• Acupuncture: Seek acupuncture therapy from a certified practitioner. 
• Massage therapy: Massage may help you relax and focus. Ask your doctor about massage therapists in your community.
• Relaxation: You may try listening to music or writing in a journal to relax.

Lifestyle modifications are necessary in order to cope with salivary gland cancer and its side effects.

Dry mouth (xerostomia) caused by radiation therapy to the head and neck area is a  major cause for discomfort and increased susceptibility to frequent infections in your mouth, cavities and problems with your teeth, and difficulty eating, swallowing and speaking. Here are some tips to relieve dry mouth: 

• Use a soft bristled toothbrush to brush your teeth several times each day. Inform your doctor about any sensitivity in your teeth. 
• Rinse your mouth with warm salt water after meals.
• Dry mouth in itself can be a cause of various oral problems. So, keep your mouth moistened with water or sugarless candies. 
• Choose moist foods: Moisten dry food with sauce, gravy, broth, butter or milk. Avoid acidic or spicy foods and drinks. 
• Choose foods and drinks that are non-irritating
• Avoid caffeinated and alcoholic beverages. 

Cancer diagnosis is a devastating experience. To cope with the trauma of the disease, follow these tips: 

• Expand and update your knowledge about your cancer. Always use reliable information resources such as National Cancer Institute and the American Cancer Society. 
• Stay close to friends and family: Find someone to talk and someone to listen to. 
• Join a support group: Stay connected to people like you. You may contact your local chapter of the American Cancer Society.
• Take care of yourself during treatment: Try your best to maintain your health through enough rest, exercise and healthy diet.

There are several risks associated with salivary gland cancer, which include:

• Age: The cancer is common among older adults. 
• Radiation exposure: Radiation used to treat head and neck cancers, puts you at a higher risk of salivary gland cancer. 
• Exposure to certain substances: People who work in rubber manufacturing, asbestos mining and plumbing industries have an increased risk of salivary gland cancer. 
• Viruses: Certain viruses such as, HIV and the Epstein-Barr virus but not human papillomavirus, appear to increase the risk of salivary gland cancer. 
• Tobacco use: Unlike in case of many types of cancers, tobacco use plays no significant role in development of salivary gland cancer.